for staff members, see your hospital's policy on Mx of needlestick injuries there is usually a pack to assist in managing staff.
for community acquired non-staff members, take bloods (BUT NOT on a staff needlestick pathology request form as this is likely to lock the results from being available) and counsel as indicated, F/U by LMO but may need review in ED after Hep B status results are available to determine need for Hep IgG and initial Hep B vaccination within 72hrs of injury (preferably within 24hrs of injury)
KEY POINT:
the pathology request form for serology should CLEARLY indicate:
whether staff member or community acquired
whether the serology specimen is for the recipient or the source
the identification of the source or recipient
wash wound
obtain history of past vaccinations - tetanus, hepatitis
tetanus prophylaxis if indicated
take blood sample from recipient of needlestick and send for urgent Hep B serology, mark “RECIPIENT” and if source known, indicate “SOURCE = ” and patient ID so the lab can correlate serology results.
if source is known, recipient should arrange for source to give a blood sample if they consent to it, this blood should be sent for Hep B, Hep C and HIV serology.
if recipient has very low hep B titres:
they should be offered hep B vaccination:
if source is Hep B +ve or unknown then IM Hep B IgG 400 IU (adult dose) should be given in OPPOSITE arm to vaccination dose, preferably within 24 hours but can be effective up to 72 hours:
Hep B IgG is usually ordered within the hospital using a blood products order form which is sent to the pathology department who will then dispense it. It should be prescribed on the blood products prescription form with written consent.
irrespective of source status, recipient should be commenced on hepatitis B vaccination course within 7 days:
eg. Hep B Engerix 1ml IM in OPPOSITE arm to IgG dose, repeat at 1 and 6 months for a total of 3 doses
there is no post-exposure risk minimisation available for hep C
discuss with recipient the pros and cons of HIV post-exposure prophylaxis, or, if a staff member, ensure recipient is reviewed by the hospital's infection control team ASAP to discuss this.
if postexposure prophylaxis (PEP) against HIV is indicated, it should be commenced as soon as possible after exposure. It is substantially less effective in animal studies when started more than 24 to 36 hours after exposure, but the interval after which no benefit is gained is unknown.
follow up testing:
HCV RNA testing at 4 to 6 weeks, and HCV antibodies and ALT at 4 to 6 months
early antiviral therapy if Hep C seroconversion occurs should be considered
HIV antibody testing at 6 weeks and 3 months, and up to 6 months,